18. Spontaneous Bacteriologic Resolution of Acute Otitis Media Pathogen % Resolved Day 5 MCAT 75% Haemophilus 50% Pneumococcus 16%

19. Categories of S. pneumoniae Susceptible to penicillin ........... ≤ 0.06 ug/ml Intermediate to penicillin ........... 0.1-1.0 ug/ml Resistant to penicillin ............ ≥ 2.0 ug/ml

21. Oral Antibiotics vs. Penicillin-intermediate S. pneumoniae

22. Bacteriologic Failure Rates in Acute Otitis Media Antibiotic Haemophilus Pneumococcus Amoxicillin 28% 5% Augmentin 22% 6% Cefaclor 38% 18% Cefuroxime 15% 8% Cefprozil 53% 8% Cefixime 3% 32% Azithromycin 80% 6% Placebo 25-50% 75-85%

23. Recommended Antibiotic Therapy of Acute Otitis Media First Line Amoxicillin (80-90 mg/kg/day; Q 8-12 hours) Second Line Augmentin (80-90 mg/kg/day; Q 8-12 hours) Cefuroxime (30 mg/kg/day; Q 12 hours) CDC Working Group on DRSP-AOM, 1998

24. Individualizing Therapy of Acute Otitis Media 5 days of therapy Older child Summer months Otitis-free (or poor) past Mild episode Prompt improvement 10 days of therapy Younger child Winter months Otitis-rich past Severe episode Slow improvement

25. The diagnosis of acute bacterial sinusitis should be based on clinical criteria in children who present with upper respiratory symptoms that are either persistent or severe.